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6001 Neurotherapeutics > Lecture 9: Upper Extremity > Flashcards

Lecture 9: Upper Extremity Flashcards

1
Q

what are the 2 main types of strokes

A

Ischemic

Hemorrhagic

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2
Q

what are the two types of ischemic strokes

A

Thrombosis: Blockage of blood vessel

Embolism: Dislodged platelets, cholesterol, or other material that travels in bloodstream and blocks a vessel

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3
Q

what is a Hemorrhagic stroke

A

Results from rupture of blood vessels
* Hypertension, Arteriovenous malformation, Aneurysm

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4
Q

effects of a stroke are determined by what

A

the location of the stroke

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5
Q

what part of the brain does the anterior cerebral artery supply blood to

A

front part of brain

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6
Q

what part of the brain does the middle cerebral artery supply blood to

A

lateral part of brain

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7
Q

what part of the brain does the posterior cerebral artery supply blood to

A

posterior part of brain

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8
Q

what are the 6 symptoms of an anterior cerebral stroke

A

contralateral sensorimotor deficit of foot and leg

arm paresis

gait ataxia

bladder incontinence

personality and behaviour changes (flat affect)

amnesia

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9
Q

what are the 6 symptoms of a middle cerebral stroke

A

contralateral sensorimotor deficit of face, arm, leg

contralateral homonymous hemianopsia

contralateral semi-spatial neglect or inattention

aphasia, Alexia, agraphia

gaze deviation towards affected hemisphere

dysarthria

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10
Q

what are the 8 symptoms of a posterior cerebral stroke

A

pure homonymous hemianopsia

nausea

vomiting

vertigo

ataxia

weakness

sensory loss

dysarthria

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11
Q

what joint is the most susceptible to changes post stroke and why

A

glenohumeral joint

it relies on muscles and tendons to keep it in place

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12
Q

what 4 things causes static stability of the shoulder joint

A

muscles

joint capsule

joint geometry

ligaments

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13
Q

which 2 groups of muscles create the dynamic stability of the shoulder

A

Scapulo-humeral Muscles (Rotator Cuff & Deltoid)
o Maintains the humeral head in the glenoid fossa

Scapulo-thoracic Muscles (Serratus Anterior)
o Moves scapula on rib cage (important for reach)

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14
Q

dynamic stability of the shoulder relies on which 3 things

A

Optimal alignment of the scapula

Correct Glenohumeral orientation

Length-tension relationship of muscles

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15
Q

Arm elevation requires which 2 types of motion

A

Scapulothoracic motion

Scapulohumeral motion

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16
Q

what is the purpose of Scapulothoracic motion

A

This significantly decrease the shearing effect between the humeral head and the glenoid

17
Q

what is the purpose of Scapulohumeral motion

A

This allows the glenoid fossa to be positioned directly under the humeral head during the end ranges of abduction to increase joint stability

18
Q

what are the 3 Prime movers for shoulder flexion

A

0 degrees > 15 = supraspinatous

15 degrees > 90 = deltoid

90 = serratus anterior

19
Q

when is scapular rotation the greatest

A

between 80 - 140°

20
Q

how can a stroke cause shoulder subluxation

A

muscles supporting the shoulder are not ‘working properly

This causes INSTABILITY in the glenohumeral joint

21
Q

what is the most common type of subluxation in stroke patients and why

A

inferior subluxation

22
Q

what does an inferior subluxation look like

A

lateral trunk flexion to weak side

scapula is downwardly rotated

23
Q

which stroke is the most likely to cause hand and arm deficits

A

middle cerebral artery strokes

24
Q

what are the 2 Key elements of upper extremity function for tool use

A

locate target (coordination of eye-head movements)

volitional motor control (reach, grasp, in-hand manipulation)

25
Q

What 3 post-stroke impairments directly impact the upper extremity?

A

Impaired motor control (upper extremity AND TRUNK)

impaired sensory perception

shoulder pain

26
Q

what is typical posture post stroke of head

A

lateral flexed toward involved side, rotation away from involved side

27
Q

what is typical posture post stroke of the upper extremity

A

scapular depression and retraction, shoulder adduction and internal rotation, elbow flexion, forearm pronation, wrist flexion, ulnar deviation, finger flexion

28
Q

what is typical posture post stroke of the trunk

A

posterior pelvic tilt, possible rotation, lateral flexion toward involved side

29
Q

what is the continuum of muscle tone

A

flaccidity

hypotonia

normal

spasticity

rigidity

30
Q

is an increase in muscle tone always bad?

A

no. we naturally have temporary increases of muscle tone when we’re in pain or nervous

31
Q

what is spasticity

A

A motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes

tight one direction, moves quickly back in other direction

31
Q

what is rigidity

A

Heightened bi-directional resistance to passive movement of the limb, independent of the velocity of stretch (non velocity dependent).

32
Q

what is the cycle for tone

A

increased spasticity

leads to immobilization and disuse

leads to contracture

this loops

33
Q

what is the impact of tone on function

A

Ranges from minor effects on the quality of movement to significant difficulties for caregiving and ADL

34
Q

what is the presentation of tone post stroke

A

U/E Flexor Synergy

35
Q

what are the 3 impacts of impaired sensation

A

Sensory feedback

Response or urge to move

Functional use even with intact motor function

36
Q

what is Hemiplegic Shoulder Pain

A

Shoulder pain present at rest, or during passive or active movement on the hemiparetic side after stroke with no history of trauma or injury

A symptom, not a diagnosis

37
Q

shoulder pain is correlated with what

A

loss of external rotation

lack of biomechanical alignment

spasticity

38
Q

what is the expectation of recovery of Hemiparetic UE Function

A

initially ~30% of stroke survivors have severe UE motor impairments

30-66% have no improvement

25% of partial recovery

5-20% have full recovery

6001 Neurotherapeutics (15 decks)

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